Healthcare Provider Details

I. General information

NPI: 1245718113
Provider Name (Legal Business Name): MEHRABIAN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 E BEVERLY BLVD STE A
MONTEBELLO CA
90640
US

IV. Provider business mailing address

249 E BEVERLY BLVD STE A
MONTEBELLO CA
90640-3799
US

V. Phone/Fax

Practice location:
  • Phone: 323-726-7500
  • Fax: 323-726-7503
Mailing address:
  • Phone: 323-726-7500
  • Fax: 323-726-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number51108
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number51108
License Number StateCA

VIII. Authorized Official

Name: DR. VAHAG MEHRABIAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 323-726-7500